title: Detection of mild to moderate influenza A/H7N9 infection by China's national sentinel surveillance system for influenza-like illness: case series.
abstract: OBJECTIVE
  To characterise the complete case series of influenza A/H7N9 infections as of 27 May 2013, detected by China's national sentinel surveillance system for influenza-like illness.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Outpatient clinics and emergency departments of 554 sentinel hospitals across 31 provinces in mainland China.
  
  
  METHODS
  Infected individuals were identified through cross-referencing people who had laboratory confirmed A/H7N9 infection with people detected by the sentinel surveillance system for influenza-like illness, where patients meeting the World Health Organization's definition of influenza-like illness undergo weekly surveillance, and 10-15 nasopharyngeal swabs are collected each week from a subset of patients with influenza-like illness in each hospital for virological testing. We extracted relevant epidemiological data from public health investigations by the Centers for Disease Control and Prevention at the local, provincial, and national level; and clinical and laboratory data from chart review.
  
  
  METHODS
  Epidemiological, clinical, and laboratory profiles of the case series.
  
  
  RESULTS
  Of 130 people with laboratory confirmed A/H7N9 infection as of 27 May 2013, five (4%) were detected through the sentinel surveillance system for influenza-like illness. Mean age was 13 years (range 2-26), and none had any underlying medical conditions. Exposure history, geographical location, and timing of symptom onset of these five patients were otherwise similar to the general cohort of laboratory confirmed cases so far. Only two of the five patients needed hospitalisation, and all five had mild or moderate disease with an uneventful course of recovery.
  
  
  CONCLUSIONS
  Our findings support the existence of a "clinical iceberg" phenomenon in influenza A/H7N9 infections, and reinforce the need for vigilance to the diverse presentation that can be associated with A/H7N9 infection. At the public health level, indirect evidence suggests a substantial proportion of mild disease in A/H7N9 infections.
authors.affiliation: Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Dennis K M
authors.initials: DK
authors.lastname: Ip
authors.forename: Qiaohong
authors.initials: Q
authors.lastname: Liao
authors.forename: Peng
authors.initials: P
authors.lastname: Wu
authors.forename: Zhancheng
authors.initials: Z
authors.lastname: Gao
authors.forename: Bin
authors.initials: B
authors.lastname: Cao
authors.forename: Luzhao
authors.initials: L
authors.lastname: Feng
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Xu
authors.forename: Hui
authors.initials: H
authors.lastname: Jiang
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.forename: Jing
authors.initials: J
authors.lastname: Bao
authors.forename: Jiandong
authors.initials: J
authors.lastname: Zheng
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhang
authors.forename: Zhaorui
authors.initials: Z
authors.lastname: Chang
authors.forename: Yu
authors.initials: Y
authors.lastname: Li
authors.forename: Jianxing
authors.initials: J
authors.lastname: Yu
authors.forename: Fengfeng
authors.initials: F
authors.lastname: Liu
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Ni
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Wu
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Cowling
authors.forename: Weizhong
authors.initials: W
authors.lastname: Yang
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Leung
authors.forename: Hongjie
authors.initials: H
authors.lastname: Yu
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D002681:China; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis* / Q000821:virology*; D008297:Male; D011159:Population Surveillance; D012720:Severity of Illness Index